Distribution and evaluation of bone and soft tissue tumors in the middle Black Sea Region

Abstract

Objective: The aim of this study was to evaluate the characteristics of bone and soft tissue tumors operated on at the Department of Orthopedics and Traumatology at Ondokuz Mayıs University Faculty of Medicine Hospital between January 1987 and January 2012. Methods: This descriptive study retrospectively evaluated 1,925 patients hospitalized with a preliminary diagnosis of tumor. Patients were analyzed for age, gender, tumor incidence and localization. Three hundred and forty-nine patients found to have non-tumor causes. The 94 patients discharged at their own request or deceased during follow-up were not included in the tumor group. Results: Of the 1,482 (76.9%) patients diagnosed with tumor, 687 (46.4%) were bone tumors, 586 (39.5%) soft tissue tumors and 209 (14.1%) metastatic tumors. The most common benign bone tumor was osteochondroma (118; 25%), followed by enchondroma (68; 14.4%) and giant cell tumor (59; 12.5%), and the most common malignant bone tumor was osteosarcoma (58; 27%), followed by chondrosarcoma (36; 16.7%) and Ewing’s sarcoma (33; 15.3%). The most common benign soft tissue tumor was cystic hygroma (96; 22%), followed by lipoma (75; 17.2%) and hemangioma (52; 11.9%), and the most common malignant soft tissue tumors were pleomorphic cell tumor (29; 19.3%) and liposarcoma (29; 19.3%), followed by pleomorphic undifferentiated sarcoma (21; 14%). Seventy (33.5%) of the metastatic tumors were of pulmonary origin, 36 (17.2%) were of breast origin and the primary site of the tumor was not clearly determined in 58 (27.8%) patients. Conclusion: The distribution of bone and soft tissue tumors appear to have certain characteristics but can show regional differences. We believe that the establishment of a larger series through the collection of these types of studies from centers in which bone and soft tissue tumor surgery is performed will provide important information on the epidemiological features of bone and soft tissue tumors.

Keywords

• Bone tumor; epidemiological features; soft tissue tumor

Orta Karadeniz bölgesindeki kemik ve yumuşak doku tümörlerinin dağılımı ve değerlendirilmesi

Öz

Amaç: Bu çalışmada Ocak 1987 ile Ocak 2012 yılları arasında Ondokuz Mayıs Üniversitesi Tıp Fakültesi Hastanesi Ortopedi Kliniğinde ameliyat edilen kemik ve yumuşak doku tümörlerinin özelliklerinin değerlendirilmesi amaçlanmıştır. Çalışma planı: Tanımlayıcı tipte olan bu araştırmada retrospektif olarak tümör ön tanısı ile yatırılan 1,925 hasta değerlendirildi. Olgular yaş, cinsiyet, tümör sıklığı ve lokalizasyonlarına göre analiz edildiler. Üç yüz kırk dokuz olguda tümör dışı nedenler saptanırken, kendi isteği ile taburcu olan ya da takibi tamamlanmayan 94 olgu da tümör grubuna katılmadı. Bulgular: Olguların 1,482’si (%76.9) tümör tanısı aldı. Kemik tümörleri 687 (%46.4), yumuşak doku tümörleri 586 (%39.5), metastatik tümörler 209 (%14.1) adet olarak saptandı. En sık görülen benign kemik tümörünün osteokondrom (118; %25), daha sonra enkondrom (68; %14.4) ve dev hücreli tümör (59; %12.5), en sık görülen malign kemik tümörünün osteosarkom (58; %27), daha sonra kondrosarkom (36; %16.7) ve Ewing sarkomu (33; %15.3) olduğu saptandı. Yumuşak doku tümörlerinde en sık görülen benign tümör olan kistik higromayı (96; %22), lipom (75; %17.2) ve hemanjiom (52; %11.9) takip ederken, en sık görülen malign yumuşak doku tümörünün pleomorfik hücreli tümör (29; %19.3) ve liposarkom (29-%19.3), daha sonra ise pleomorfik undifferansiye sarkom (21; %14) olduğu gözlendi. Metastatik tümörlerin 70’inin (%33.5) akciğer kaynaklı, 36’sının (%17.2) meme kaynaklı olduğu, 58’inde (%27.8) ise primerinin net belirlenemediği saptandı. Çıkarımlar: Kemik ve yumuşak doku tümörlerinin dağılımına dair belli karakteristikler olduğu gözükse de, aralarında bölgesel farklar olabilmektedir. Bu tip çalışmaların kemik ve yumuşak doku tümörleri cerrahisi yapılan merkezlerden toplanarak daha geniş serilerin oluşturulmasının kemik ve yumuşak doku tümörlerinin epidemiyolojik özellikleri açısından önemli bilgiler sağlayacağını düşünüyoruz.

Anahtar Kelimeler

• Epidemiyolojik özellikler; kemik tümörü; yumuşak doku tümörü

Kaynakça

1. Kosem M, Bayram I. Distribution and evaluation of ex- tremity, bone and soft tissue tumors in Van region. Van Medical Journal 2001;8:93-6.
2. Solakoğlu D, Benzer E. Distribution of bone tumors ac- cording to age, sex and tumor site. Acta Oncologica Tur- cica 2005;38:38-43.
3. Güngör Ş. Demographic features of childhood benign bone tumors and evaluation of clinical approach. Acta Oncologica Turcica 2008;41:7-13.
4. Yücetürk G, Sabah D, Keçeci B, Kara AD, Yalçinkaya S. Prevalence of bone and soft tissue tumors. Acta Orthop Traumatol Turc 2011;45:135-43.
5. Baena-Ocampo Ldel C, Ramirez-Perez E, Linares-Gon- zalez LM, Delgado-Chavez R. Epidemiology of bone tu- mors in Mexico City: retrospective clinicopathologic study of 566 patients at a referral institution. Ann Diagn Pathol 2009;13:16-21.
6. van den Berg H, Kroon HM, Slaar A, Hogendoorn P. In- cidence of biopsy-proven bone tumors in children: a re- port based on the Dutch pathology registration “PALGA”. J Pediatr Orthop 2008;28:29-35.
7. Gebhardt MC, Ready JE, Mankin HJ. Tumors about the knee in children. Clin Orthop Relat Res 1990;255:86- 110.
8. Rosai J. Ackerman’s surgical pathology. Bone and Joint Tu- mors. 8th ed. St. Louise: Mosby; 1996. p. 1917-2019.

9. Copley L, Dormans JP. Benign pediatric bone tumors. Evaluation and treatment. Pediatr Clin North Am 1996;43:949-66.
10. Sternberg SS. Diagnostic surgical pathology. In: Inwards CY, Unni KK, editors. Bone tumors. 3rd ed. New York: Raven Press; 1999. p. 263-315.
11. Dorfman HD, Czerniak B. Bone cancers. Cancer 1995;75(1 Suppl):203-10.
12. Pongkripetch M, Sirikulchayanonta V. Analysis of bone tumors in Ramathibodi Hospital, Thailand during 1977- 1986: study of 652 cases. J Med Assoc Thai 1989;72:621- 8.
13. Schajowicz F. Current trends in the diagnosis and treat- ment of malignant bone tumors. Clin Orthop Relat Res 1983;180:220-52.
14. Campanacci M. Bone and soft tissue tumors. In: Mirra MS, editor. Malignant tumors. 2nd ed. Bologna: Springer- Verlag; 1999. p. 459-549.
15. Schubiner JM, Simon MA. Primary bone tumors in chil- dren. Orthop Clin North Am 1987;18:577-95.
16. Inwards CY, Unni KK. Classification and grading of bone sarcomas. Hematol Oncol Clin North Am 1995;9:545- 69.
17. Larsson SE, Lorentzon R. The incidence of malignant primary bone tumours in relation to age, sex and site. A study of osteogenic sarcoma, chondrosarcoma and Ewing’s sarcoma diagnosed in Sweden from 1958 to 1968. J Bone Joint Surg Br 1974;56B:534-40.
18. Solooki S, Vosoughi AR, Masoomi V. Epidemiology of musculoskeletal tumors in Shiraz, south of Iran. Indian J Med Paediatr Oncol 2011;32:187-91.
19. Kransdorf MJ. Malignant soft-tissue tumors in a large referral population: distribution of diagnoses by age, sex, and location. AJR Am J Roentgenol 1995;164:129-34.
20. Turek’s Orthopaedics Principles and Their Application. In: Weinstein SL, Buckwalter JA, editors. Alpaslan M, translator and editor. Philadelphia: Lippincott Williams & Wilkins. Güneş Bookshop, Oncu Printing Office; 2009. p. 316-8.
21. Lange Current Orthopaedics Current Diagnosis and Treatment. In: Skinner HB, editor. Alpaslan M, translator and editor. New York: Lange Medical Books/McGraw- Hill, Güneş Bookshop, Oncu Printing Office; 2005. p. 350-60.
22. Campbell’s Operative Orthopaedics. In: Canale ST, edi- tor. Akgun I, translator and editor. Vol. 1, 10th ed. Turkish Edition. 2007. p. 848-54.
23. Dahlin’s Bone Tumors. In: Unni KK, Inwards CY, editors. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 354-8.